Transmission of Oriental Tsutsugamichi from a Deceased Donor to Three Organ Transplant Recipients in Thailand

Abstract

Introduction: Donor-derived infection is rare but growing numbers of cases have increasingly been recognized. We illustrated 3 patients (2 kidneys and 1 liver transplant recipients) who suffered from unexplained clinical symptoms and signs but suggestive of systemic infections following organ transplantation from a common donor. Methods: We performed investigation including detailed medical history of the donor, and examined clinical specimen from the donor and three solid organ recipients using serologic testing and molecular analysis to identify a cause. Results: In February, 2011 two kidney transplant recipients and one liver transplant recipient developed acute high-graded fever 2 weeks after the transplantation. The significant symptoms of kidney recipients also included polyarthralgia and hematuria. Despite an extensive investigation, the cause of their illness remained unknown. Further detailed history showed that the deceased donor was a truck driver who presented to the hospital in comatose from spontaneous intracerebral hemorrhage. However, 3 weeks before his death, his wife reported the history of patient's sub-acute onset of fever which was self-resolved. Following an interview, retrospective analysis of the donor's blood was subsequently analyzed and was positive by IgM and IgG for scrub typhus. Treatment with oral doxycycline resulted in significant clinical improvement of the three cases. Further molecular analysis of the three recipients' blood matched the same strain of Oriental. tsutsugamuchi. Conclusions: We document the first world report of Oriental tsutsugamuchi infection transmitted through organ transplantation.